Provider Demographics
NPI:1477519098
Name:SANDIN, JAMES HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HOWARD
Last Name:SANDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4818 WELLLINGTON
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402
Mailing Address - Country:US
Mailing Address - Phone:903-455-0955
Mailing Address - Fax:903-455-0356
Practice Address - Street 1:4818 WELLLINGTON
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402
Practice Address - Country:US
Practice Address - Phone:903-455-0955
Practice Address - Fax:903-455-0356
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1794208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000L7476Medicaid
00L747Medicare ID - Type Unspecified
C21545Medicare UPIN